Short-term volunteer staffing of a hospital.

We surveyed 136 physicians, nurses, dentists, physician assistants, and other medical professionals who were residents of the United States and had volunteered their professional services for 6 months or less from October 1992 through January 1994 at St. Jude Hospital, a rural hospital on the island of St. Lucia in the southern Caribbean. This hospital has relied almost entirely on volunteer staffing over the past 27 years. The survey explored motivations for volunteering, opinions on medical care, and personal background. Of those who returned the questionnaire (a 68% response rate), 98% considered overall care to be adequate or better than adequate despite limited hospital facilities and frequent changes of personnel. Seventy-seven percent cited unavailability of opportunities, limited backup mediated coverage in locales where they might want to volunteer, and concerns about licensing and insurance as reasons for not doing volunteer work in the United States.

Intestinal obstruction from cecal bezoar; a complication of fiber-containing tube feedings.

Dietary fiber increases stool bulk, regulates bowel transit time, and decreases intraluminal pressure. Because these actions constitute a natural way to stop diarrhea, a frequent problem with tube feedings, enteral tube feeding manufacturers have marketed several fiber-containing formulae. While bulk-forming agents such as fiber may not be appropriate for every tube-fed patient, we were unable to find any published contraindications to the use of fiber-containing enteral products. We present the case of a seriously ill man who received a fiber-containing tube feeding while also getting intestinal motility-suppressing medications. A large fiber bezoar developed, with resultant mesenteric hemorrhage. We conclude that fiber-containing tube feedings are contraindicated in certain types of patients.